Abstract
Although adjuvant chemotherapy is considered standard of care for completely resected NSCLC patients with pathologic stage II–III, elderly patients are clearly underrepresented in the adjuvant randomized trials. Furthermore, the positive adjuvant chemotherapy trials employed cisplatin, which is considered a toxic drug in the elderly population. Another consideration is that recovery from surgery can take longer in elderly patients for age-related reasons, and a slow recovery from surgery is also a relevant factor when we consider adjuvant treatment. Subset analyses of NCIC-BR10 and LACE suggest that elderly patients benefit from adjuvant chemotherapy without increased toxicity although almost no information in patients aged ≥80 years was seen because of the extremely low proportion of patients ≥80 years included. Due to the lack of prospective data regarding the use of adjuvant chemotherapy in elderly patients, no general recommendations can be made, and the best approach is to individualize treatment for each patient taking into consideration, factors such as comorbidities, ECOG PS, previous surgical procedure, and, more importantly, patient preference.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69.
Nesbitt JC, Putnam Jr JB, Walsh GL, et al. Survival in early-stage non-small cell lung cancer. Ann Thorac Surg. 1995;60:466–72.
Crinò L, Weder W, van Meerbeeck J, et al. Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v103–15.
Pisters KM, Evans WK, Azzoli CG, et al. Cancer Care Ontario and American Society of Clinical Oncology adjuvant chemotherapy and adjuvant radiation therapy for stages I-IIIA resectable non small-cell lung cancer guideline. J Clin Oncol. 2007;25:5506–18.
Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ. 1995;311:899–909.
Keller SM, Adak S, Wagner H, et al. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIA non-small-cell lung cancer. Eastern Cooperative Oncology Group. N Engl J Med. 2000;343:1217–22.
Scagliotti GV, Fossati R, Torri V, et al. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell lung cancer. J Natl Cancer Inst. 2003;95:1453–61.
Waller D, Peake MD, Stephens RJ, et al. Chemotherapy for patients with nonsmall cell lung cancer: the surgical setting of the Big Lung Trial. Eur J Cardiothorac Surg. 2004;26:173–1782.
Arriagada R, Bergman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350:351–60.
Arriagada R, Dunant A, Pignon JP, et al. Long-term results of the international adjuvant lung cancer trial evaluating adjuvant Cisplatin-based chemotherapy in resected lung cancer. J Clin Oncol. 2010;28:35–42.
Douillard JY, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin vs. observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol. 2006;7:719–27.
Douillard JY, Rosell R, De Lena M, et al. Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non-small-cell lung cancer treated with adjuvant chemotherapy: the adjuvant Navelbine International Trialist A(ANITA) Randomized Trial. Int J Radiat Oncol Biol Phys. 2008;72:695–701.
Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005;352:2589–97.
Butts CA, Ding K, Seymour L, et al. Randomized phase III trial of vinorelbine plus cisplatin compared with observation in completely resected stage IB and II non-small-cell lung cancer: updated survival analysis of JBR-10. J Clin Oncol. 2010;28:29–34.
Strauss GM, Herndon JE, Maddaus MA, et al. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol. 2008;26:5043–51.
Pignon JP, Tribodet H, Scagliotti GV, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26:3552–9.
NSCLC Meta-analyses Collaborative Group, Arriagada R, Auperin A, Burdett S, et al. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet. 2010;375:1267–77.
Kato H, Ichinose Y, Ohta M, et al. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med. 2004;350:1713–21.
Pepe C, Hassan B, Winton T, et al. Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and Intergroup Study JBR.10. J Clin Oncol. 2007;25:1553–61.
Früh M, Rolland E, Pignon JP, et al. Pooled analysis of the effect of age on adjuvant cisplatin-based chemotherapy for completely resected non-small-cell lung cancer. J Clin Oncol. 2008;26:3573–81.
Cuffe S, Booth CM, Peng Y, et al. Adjuvant chemotherapy for non-small cell lung cancer in the elderly: A population-based study in Ontario, Canada. J Clin Oncol. 2012;30(15):1813–21.
Gu F, Strauss GM, Wisnivesky JP. Platinum-based adjuvant chemotherapy (ACT) in elderly patients with non-small cell lung cancer (NSCLC) in the SEER-Medicare database: Comparison between carboplatin- and cisplatin-based regimens. ASCO Meeting Abstracts. 2011;29:7014.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag London
About this chapter
Cite this chapter
Navarro, A., Felip, E. (2013). Adjuvant Chemotherapy: Feasibility in the Elderly and Patient Selection. In: Gridelli, C., Audisio, R. (eds) Management of Lung Cancer in Older People. Springer, London. https://doi.org/10.1007/978-0-85729-793-8_12
Download citation
DOI: https://doi.org/10.1007/978-0-85729-793-8_12
Published:
Publisher Name: Springer, London
Print ISBN: 978-0-85729-792-1
Online ISBN: 978-0-85729-793-8
eBook Packages: MedicineMedicine (R0)